Monday, April 06, 2009

Why doesn't anyone really talk health care?

What I'm about to say may strike some as heretical, but I believe it must be said and the moment for it being said is way overdue. First, I'll admit that it is outrageous that so many lack health insurance or are underinsured. I'll also recognize that there are many insurance horror stories to be found concerning pre-existing conditions and rising premiums. Now, here comes my sacrilege: A great deal of the time, for those lucky enough to have health insurance, the insurers are the good guys. The bad guys? Hospitals. Doctors. All other aspects of the health care industry.

My first-hand experience could be dismissed as anecdotal but I've heard so many nitwits speak out their ass about the subject that I feel I have to speak up. One morning on MSNBC, Joe Scarborough said that people are going to have to accept that they can't have a second CAT scan just because they want one. Ask yourself: Have you ever known anyone who wanted a second medical test, especially one they just had? Other than hypochondriacs that is. What a ridiculous comment. Last year, during three-and-a-half-months I had to spend in the hospital, I had to have an ultrasound on my right leg two days in a row. Was it because I loved the test so much I had to have it again? No. It was because a clerical error had them do it on my veins the first day when they were supposed to it on my arteries. It took months of fighting with the hospital and the separate billing unit that performed the test to get the cost of the incorrect test taken off. The insurance would have paid anyway, at no cost to us, if we hadn't fought, but we'd built up a good relationship with our insurance case manager.

I have primary progressive multiple sclerosis. Following bladder surgery last year, I ended up with a pressure wound that hospitalized me for three and a half months and continues to keep me bedridden. Because of careful recordkeeping by myself and my father, we discovered duplicate billing, overcharges, charges for things that didn't have, etc. by various health care sources that came to a whopping total of more than $24,000. In a local newspaper story here, the CEO of a hospital here, a not-for-profit, religious-affiliated hospital mind you, openly admitted that if he had three patients in adjacent rooms using the same equipment, he would charge them based on their insurance i.e., the better they had, the more they charged. For the same equipment.

If you have medication you take every day, you can't bring them from home. No, the hospital has to supply them so they can make sure they get no generics, at a higher rate that they can stick you for.

I spent 27 days in the first hospital where they did essentially nothing for the wound. There was talk of moving me to a speciality hospital for specialized care, but the hospital lied and said you couldn't do it until after a 27-day mark. Of course, the hospital was lying and could have transferred me within two weeks, but they wanted to squeeze more money out while my wound grew worse in the interim. Profit comes before patient care at most hospitals, where they purposely understaff nurses and support staff, blame the nursing shortage, but save money and let patient care suffer.

I've vented enough. Just remember. Having insurance doesn't solve the health care crisis. Someone needs to crack down on the health care industry, you know, the way they should have done on the banks and Wall Street.

3 Comments:

This is so true. It has been a while since I editing a healthcare finance magazine, but all the CFOs were bellyaching that they couldn't make do with the reimbursement rates Medicare was paying. Yet, they wouldn't acknowledge the huge waste in the system, from throwing out wrapped instruments that fell on the floor (there was no contamination, it's just superstition) to massive in-hospital infections they couldn't or wouldn't control, which could have saved lives as well as money.

Some insurers have been playing games with our money, there's no question, but most are there when you need them. I know when my mom was dying, she ran up bills of $250,000 (can you imagine?!) and we didn't have to pay a cent. Not one.